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The Allure of Instant Orthodontics

"We call it 'instant orthodontics,"' says Dr. David Hombrook, DDS, FAACD, a San Diego dentist who specializes in cosmetic and restorative procedures. "We can straighten severely crooked teeth in two weeks rather than two years."

The benefits of veneers over other cosmetic dentistry options are many: they're extremely durable (lasting an average of more than 36 10 to 12 years), are virtually painless to place, and are easy to maintain. "Veneers are a very conservative option," adds Dr. Hombrook. "Newer bonding agents allow us to use the underlying tooth as a foundation rather than removing part of the tooth and replacing it with metal. This eliminates that dark gray look, often seen at the gumline of crowns and caps. We also don't go beneath the gumline as with crowns.

"The biggest drawback, some would say, is price, which can run anywhere from $500 to $2,000 per tooth, depending on the difficulty of the particular case, as well as the experience and education of the clinician (the one who works on your teeth), and the ceramist (the one who actually constructs the veneers). Of course, we spend billions of dollars every year on clothing, make-up, gym memberships, and plastic surgery in an effort to look our best. Clearly, there's a market for self-improvement products like porcelain veneers.

"We're not just fixing teeth, we're designing smiles," says Dr. Hornbrook. "I like to think of a smile as a beautiful work of art: the teeth are a picture, the gums are the matting, the lips are the frame, and the face is the wall the picture would be hanging on. Everyone will have a custom-designed smile based on their age, face shape, hair and skin color, and personality type."

Often, the design process begins with computer imaging, where the dentist snaps your picture and within seconds, plugs in several different selections from a "smile file" to show you what veneers might do for you. "We call it the 'wow factor,"' says Dr. Hombrook of the response the imaging process invariably elicits. "People often don't understand the difference a new smile can make." In fact, choosing the right color for your veneers, can significantly lighten and brighten your smile. If you like what you see in the digital image, your dentist can make a mockup using an epoxy-­like resin to approximate what your final result will look like. This way you can see not only how the new shape/color/structure will look from every angle, but also how it will feel in your mouth. "There's not a woman in the world who would buy a cocktail dress without trying it on first," says Dr. Hombrook. "We want our patients to make the same kind of informed decisions."

Once you're sold on the process, into the chair you go. First, a local anesthetic is administered. If you're painfully needle shy, you'll be happy to know that new computer-controlled injection machines dispense anesthetic so slowly that the process is virtually painless. After your gums are numb, the dentist uses a diamond bur (more commonly known as a drill, but why use that word unnecessarily?) to remove anywhere from 0.5 mm to 1.5 mm from the surface of the teeth being treated. This filing allows the dentist to make room for the veneers to ensure that the result won't be bulky. Next, the dentist takes an impression of your prepped teeth, which will be sent to the lab that builds your veneers. Using a model of the original mockup, the dentist then makes provisionals, or "temporary teeth" for you to wear until the finished product returns from the lab. "The provisionals actually look fabulous," reassures Dr. Hornbrook. "You can't even tell they're temporary."

This is your opportunity to really "test drive" your new teeth, to make sure the shade, the shape, and the length are exactly what you want. Over the course of the next week or two as you wait for your permanent porcelain veneers to be crafted, if there's something you decide you don't like, your dentist can still easily remedy it. A week or two later, depending on the lab's turn­ around time, the "real deal" arrives and you'll return to have them installed. (Both the first appointment and this one will last anywhere from 2 to 4 hours, depending on how many teeth you're having done, so be sure to block out enough time.) "When we take off the provisionals, we go through a bonding protocol to maximize the strength of the hold of the veneers to the teeth," explains Dr. Hornbrook. First, the teeth being treated are etched with phosphoric acid to create a surface that will be highly receptive to bonding. Then a dental adhesive is applied, followed by a resin cement that actually bonds the veneer to the tooth. "The porcelain is actually translucent, so you get the underlying tooth color shining through." 

Dr. Hornbrook says. "This is very different from a crown, where the base is a dark gray metal that we're forced to paint white before building a natural looking tooth on top of it. Crowns can look flat and fake, but veneers look vital and very natural." Which brings us to yet another advantage of veneers: the dentist has total control over the final color. With bleaching, you can hope and anticipate, but you can never guarantee. This method is foolproof: the shade you pick is the shade you get. Other than the obvious caveats (don't bite your fingernails or chew on bobbypins), the upkeep of your new teeth is pretty basic. Some initial sensitivity is to be expected, although this should only last a few days. You'll brush and floss as you normally do, although you'll want to avoid prescription-grade fluoride rinses which can stain porcelain surfaces. You'll also want to be sure that your hygienist doesn't use an ultrasonic scaler (the vibrating cleaning tool that removes tartar) during   cleanings, as these can damage the cement, as well as fracture the porcelain. Finally, if you're a notorious nighttime tooth grinder or you play any potentially injurious sports (basketball, racquetball, soccer), you might seriously consider getting fitted for a professional mouthguard.